title: Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa.
abstract: To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mm Hg). After ≥4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (n=89; R) or amlodipine/valsartan 5/160 mg (n=94; E) and followed up for 6 months. To control blood pressure (<140/<90 mm Hg), bisoprolol and amlodipine could be doubled (10 mg per day) and α-methyldopa (0.5-2 g per day) added. Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients (-0.2 beats per minute). The between-group differences (R minus E) were 5.2 mm Hg (P<0.0001) systolic, 1.3 mm Hg (P=0.12) diastolic, and 9.6 beats per minute (P<0.0001). In 57 R and 67 E patients with data available at all visits, these estimates were 5.5 mm Hg (P<0.0001) systolic, 1.8 mm Hg (P=0.07) diastolic and 9.8 beats per minute (P<0.0001). In R compared with E patients, 45 vs 37% (P=0.13) proceeded to the higher dose of randomised treatment and 33 vs 9% (P<0.0001) had α-methyldopa added. There were no between-group differences in symptoms except for ankle oedema in E patients (P=0.012). In conclusion, new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients.
authors.affiliation: 1] Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium [2] Hypertension Unit, Department of Internal Medicine, University of Kinshasa Hospital, Kinshasa, Democratic Republic of Congo.
authors.forename: J R
authors.initials: JR
authors.lastname: M'Buyamba-Kabangu
authors.forename: B C
authors.initials: BC
authors.lastname: Anisiuba
authors.forename: M B
authors.initials: MB
authors.lastname: Ndiaye
authors.forename: D
authors.initials: D
authors.lastname: Lemogoum
authors.forename: L
authors.initials: L
authors.lastname: Jacobs
authors.forename: C K
authors.initials: CK
authors.lastname: Ijoma
authors.forename: L
authors.initials: L
authors.lastname: Thijs
authors.forename: H J
authors.initials: HJ
authors.lastname: Boombhi
authors.forename: J
authors.initials: J
authors.lastname: Kaptue
authors.forename: P M
authors.initials: PM
authors.lastname: Kolo
authors.forename: J B
authors.initials: JB
authors.lastname: Mipinda
authors.forename: C E
authors.initials: CE
authors.lastname: Osakwe
authors.forename: A
authors.initials: A
authors.lastname: Odili
authors.forename: B
authors.initials: B
authors.lastname: Ezeala-Adikaibe
authors.forename: S
authors.initials: S
authors.lastname: Kingue
authors.forename: B A
authors.initials: BA
authors.lastname: Omotoso
authors.forename: S A
authors.initials: SA
authors.lastname: Ba
authors.forename: I I
authors.initials: II
authors.lastname: Ulasi
authors.forename: J A
authors.initials: JA
authors.lastname: Staessen
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D017311:Amlodipine / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D017298:Bisoprolol / Q000627:therapeutic use; D044383:Black People; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D013777:Tetrazoles / Q000627:therapeutic use; D016896:Treatment Outcome; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D017311:Amlodipine; D000068756:Valsartan; D014633:Valine; D017298:Bisoprolol